A woman receives food at a makeshift relief camp on the outskirts of Sukkur, in Pakistan’s Sindh province. Photo by: Asad Zaidi / CC BY-NC-ND

Last month’s World Food Day came as a grim reminder of the number of children the world loses due to undernutrition each year.

Undernutrition is especially unkind to the poorest of the poor, who cannot afford a staple diet of high-quality, nutritious food.

Despite the economic and technological progress many nations are witnesses, the conditions for children — especially in low-to-middle income countries — continues to be deplorable, with 3.1 million children under the age of 5 dying each year due to undernutrition.

This puts the next generation at extreme risk. The need is great for the world to recognize that millions of our most vulnerable people don't get enough iron, iodine, vitamin A, folic acid and zinc in their diets — leading to illness, blindness, mental disorders and increased risk of death.

Pakistan ‘no exception’

Pakistan is no exception when it comes to undernutrition. According to the National Nutrition Survey 2011, nearly half of Pakistan’s children and mothers suffer from undernutrition. When pregnant women are affected by a lack of essential nutrients, they and their babies are at increased risk of long-term disease and early death. The NNS found that 44 percent of children under the age of 5 are stunted — 15 percent suffer from wasting and 32 percent are underweight.

The study also found that more than half of all Pakistani women are anaemic, mostly due to iron deficiency. During pregnancy, this condition becomes particularly alarming, as anaemia contributes to maternal mortality. One-third of children in Pakistan also suffer from anaemia, hindering their growth and making them vulnerable to disease, disability and death.

But there is good news when it comes to battling undernutrition in Pakistan. There are solutions that have worked well. One such example is the Micronutrient Initiative’s salt iodization program, which has led to a marked decreased in the incidence of severe iodine deficiency — from 37 percent and 23 percent in women of reproductive age and school-age children (according to the 2001-02 NNS), to just 3 percent and 2 percent respectively (according to the 2011 NNS).

‘Grow better brains’

Iodine deficiency is the single greatest and preventable cause of mental impairment. In Pakistan, we are working hard to grow better brains so children can survive, thrive and develop to their full potential.

In order to combat the wider spread of anaemia in Pakistan, wheat flour — a key staple — is being fortified with iron. This initiative is already underway in various regions of Pakistan. In partnership with the government, MI plans to scale up interventions nationally to address the urgent iron deficiency problem.

Both iron deficiency and anaemia reduce energy levels and the capacity of people to fully function and live healthily in their communities and their daily lives. It especially impacts pregnant women. During pregnancy, a woman’s need for iron increases because both fetus and placenta require iron to thrive. A sick or depleted mother has more potential to deliver a sick or depleted baby. Lack of iron is linked to a woman’s risk of experiencing post-partum hemorrhage and overall blood loss. About 50,000 women die in childbirth each year due to a lack of iron. In addition, studies have shown that infants with anaemia caused by iron deficiency have lower mental scores and lower motor scores. Fortifying an everyday staple is helping to address Pakistan’s anaemia issues, and helping those affected live a healthier life.

Mapping the salt industry

MI brought together the first-ever salt inventory to map the salt industry in Pakistan and create the country’s universal salt iodization program. Similarly, between 2002 and 2003, MI commissioned a study on the fortification of wheat flour with iron and folic acid, conducted by the Pakistan Institute of Nuclear Science and Technology, or PINSTECH.

Based on that study’s findings, with support from the Canadian government, MI implemented multiple wheat fortification projects in different districts of Pakistan and Azad Jammu & Kashmir. These projects used a multi-pronged approach to reach various stakeholders: the millers to fortify the flour; the consumers to adopt complementary health-promoting behaviors; the Pakistani government to work towards mandatory status of fortification; and development partners to pledge more resources to address malnutrition.

The AJ&K Wheat Flour Fortification Project is now being scaled up to reach 4 million people and will serve as a model for scaling up similar interventions across the country.

Direct interventions

Globally, the evidence base and the science for improving nutrition outcomes — through direct interventions — are relatively well established. Fortification of food, by and large, is the single most effective intervention to combat undernutrition. Lessons learned from existing work on fortification need to be scaled up nationally so more people can be reached, no matter where they live.

In Pakistan, and elsewhere, nutrition must become an intrinsic part of existing preventative and curative care services, both in content – information and counseling given to women and families about nutrition — and in services — blanket provision of micronutrient supplements through fortification. The problem of undernutrition in Pakistan must be dealt with collaboratively, by using a multi-sectoral approach, involving not only the health and food departments, but other sectors that indirectly contribute to improving nutrition: namely education, agriculture, industry, and so on. It needs to be over-emphasized that interventions in combating undernutrition go a long way towards a healthy, productive and developmental nation.

MI has been working in Pakistan for 14 years. We continue to offer a decisive voice on Pakistan’s undernourished status and are committed to working to maximize the value of every bit of money spent on our fight against this problem, with a particular focus on nourishing children under the age of 5.

We all must ensure that strong political will already harnessed for this vital cause does not ebb in the future. In the coming years, good nutrition must be the new “tradition” for Pakistan — and a priority for development partners in this country — as we strive to help everyone live a long and healthy life.

Want to learn more? Check out the Healthy Means campaign site and tweet us using #HealthyMeans.

Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.

The views in this opinion piece do not necessarily reflect Devex's editorial views.

About the author

  • Tausif Akhtar Janjua

    Dr. Tausif Akhtar Janjua has more than 20 years of experience in conceiving, planning and implementing community-based public health initiatives in rural and underserved environments. He has worked with the Micronutrient Initiative since 2007 and became director for Pakistan in 2012. He leads overall development, design and management of MI Pakistan’s country programs in consultation with MI Asia and MI headquarters.